Revascularization Strategies for Calcified Lesions in Patients Presenting with Acute Coronary Syndromes (From the Acute Catheterization and Urgent Intervention Triage StrategY [ACUITY] Trial)

BACKGROUND: Revascularization of calcified coronary lesions has been shown to be associated with suboptimal outcomes. The optimal revascularization strategy for calcified lesions in patients presenting with non-ST segment elevation acute coronary syndromes (NSTEACS) has yet to be defined. METHODS: Outcomes in patients presenting with NSTEACS and moderately or severely calcified target lesions in native coronary vessels, as assessed by an independent angiographic core lab, were examined according to revascularization strategy (percutaneous coronary intervention [PCI] vs coronary artery bypass graft [CABG] surgery) from the large-scale, prospective ACUITY trial. Propensity-adjusted multivariable analysis was used to identify the independent predictors of events at 30 days. RESULTS: Of 1315 NSTEACS patients with moderately and severely calcified lesions in whom revascularization was performed, a total of 334 (25%) and 981 (75%) underwent CABG and PCI, respectively. CABG patients had more severe baseline comorbidities and coronary artery disease. By propensity-adjusted multivariable analysis, the CABG group had higher 30-day rates of reinfarction, composite death or reinfarction, major bleeding, and thrombocytopenia. CONCLUSIONS: In this large-scale study of patients presenting for NSTEACS, 30-day adverse events were more frequent after revascularization of calcified coronary lesions with CABG rather than PCI. Further studies are warranted to evaluate means of improving early safety outcomes in this high-risk patient group with complex coronary disease.